Provider Demographics
NPI:1003675885
Name:CUETO, ADRIAN DEJESUS
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DEJESUS
Last Name:CUETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W CARROLL ST APT 89
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-6854
Mailing Address - Country:US
Mailing Address - Phone:808-940-4906
Mailing Address - Fax:
Practice Address - Street 1:5555 E MICHIGAN ST STE 104
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2700
Practice Address - Country:US
Practice Address - Phone:808-940-4906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA103394225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty